Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

Abstract

Background: Opioids are commonly used to treat postoperative pain; however, guidelines vary regarding safe opioid use after hip arthroscopy. Purpose/Hypothesis: The purposes were to (1) identify risk factors for persistent opioid use, (2) assess the effect of opioid use on outcomes, and (3) describe common opioid prescribing patterns after hip arthroscopy. It was hypothesized that preoperative opioid use would affect complication rates and result in greater postoperative opioid use. Study Design: Case-control study; Level of evidence 3. Methods: The Utah State All Payer Claims Database was queried for patients who underwent hip arthroscopy between January 2013 and December 2017. Included were patients ≥14 years of age at index surgery with continuous insurance. Patients were separated into acute (<3 months) and chronic (≥3 months) postoperative opioid use groups. Primary outcomes included revision surgery, complications (infection, pulmonary embolism/deep venous thrombosis, death), emergency department (ED) visits, and hospital admissions. Multivariate logistic regression was utilized to identify factors associated with the outcomes. Results: Included were 2835 patients (mean age, 47 years; range, 14-64 years), of whom 2544 were in the acute opioid use and 291 were in the chronic opioid use group. Notably, 91% of the patients in the chronic group took opioid medications preoperatively, and they were more than twice as likely to carry a mental health diagnosis ( P < .01). Patients in the acute group had a significantly shorter initial prescription duration, took fewer opioid pills, and had fewer refills than those in the chronic group ( P < .01 for all). Patients in the chronic group had a significantly higher risk of postoperative ED visits (odds ratio [OR], 2.76; P = .008), hospital admission (OR, 3.02; P = .002), and additional surgery ( P = .003), as well as infection (OR, 2.55; P < .001) and hematoma (OR, 2.43; P = .030). Patients who had used opioids before hip arthroscopy were more likely to need more refills ( P < .01). A formal opioid use disorder diagnosis correlated significantly with postoperative hospital admissions (OR, 3.83; P = .044) and revision hip arthroscopy (OR, 4.72; P = .003). Conclusion: Mental health and substance use disorders were more common in patients with chronic postoperative opioid use, and chronic postoperative opioid use was associated with greater likelihood of postoperative complications. Preoperative opioid use was significantly correlated with chronic postoperative opioid use and with increased refill requests after index arthroscopy.

Risk factors for prolonged opioid consumption following hip arthroscopy: A secondary analysis of the Femoroacetabular Impingement RandomiSed controlled Trial and embedded cohort study

“…This analysis is similar to other literature which has shown that preoperative opioid use is a risk factor for prolonged opioid use following hip arthroscopy [2,5,11,23,28,33]. Similar patterns have been observed in various other orthopaedic surgeries, including anterior cruciate ligament reconstruction (ACLR) [3], total joint arthroplasty [27,43] and orthopaedic trauma [27], further highlighting the broader relevance of this risk factor for postoperative opioid use.…”

“…While female sex has been demonstrated to be a possible risk factor for inferior clinical outcomes following hip arthroscopy [18], it is unclear if female sex is a risk factor for prolonged postoperative opioid use [2, 11, 33]. This finding is consistent with some literature pertaining to ACLR [3, 31], arthroplasty [43] and trauma [27] but is likely multifactorial and of importance for ongoing research.…”

Older Age, Female Sex, Anxiety, Substance Use Disorder, Osteoarthritis, Tibial Tubercle Osteotomy, and Opioid Familiarity Are Risk Factors for Prolonged Opioid Use Following Medial Patellofemoral Ligament Reconstruction

“…Kunkel et al 23 found a 5-fold and 4-fold increase in the percentage of patients with chronic opioid use following THA and total knee arthroplasty (TKA), respectively. Rogers et al 24 analyzed hip arthroscopy patients, finding that those who used opioids before the procedure needed more refills following the procedure. Also, patients with a formal opioid use disorder diagnosis had significantly greater risk for revision hip arthroscopy.…”

Postoperative Opioid Usage and Disposal Strategies After Arthroscopic Procedures in a Young Cohort: A Prospective Observational Study

“… 11 Similar high-level studies have been performed with respect to anterior cruciate ligament reconstruction (ACLR), 15 , 20 , 41 meniscal procedures, 30 , 46 and hip arthroscopy. 9 , 28 However, a survey of the American Academy of Orthopaedic Surgeons (AAOS) attendees highlighted many inconsistencies, and often excess, in opioid prescription patterns after common procedures, 35 and reliable, evidence-based opioid prescription recommendations after various arthroscopic procedures are sparse. 27 , 30 The purpose of this study was to both quantify the amount of opioid prescription used after common sports medicine surgeries (meniscectomy, meniscal repair, ACLR with various graft selections, and hip and shoulder arthroscopy with labral repair) and further understand the allocation of opioid pain medications that go unused.…”